Last week, Congress passed and President Biden signed a three-month stopgap spending bill that will fund the government through December 20th. The stopgap was born after much internal Republican disagreements and House and Senate back-and-forth. Speaker Mike Johnson (R-LA) best highlighted the focus of Hill legislators after the measure passed by stating, “Our focus now turns exclusively to Nov. 5th,” as the election buzz now takes center stage.

What’s in the CR? What was left out?

Congress delayed looming cuts to hospitals, extended community health center funding, maintained federal nutrition programs, and addressed a slew of other health care priorities. Additionally, the bill boosted funding for the U.S. Secret Service by $231 million, following two assassination attempts on former President Donald Trump.

The Bill was void of President Trump’s priority legislation, the Safeguard American Voter Eligibility Act (SAVE) (H.R. 8281), which would have required voters to show proof of citizenship before registering to vote in federal elections – a point of contention that divided Republicans and led to 86 House Republicans opposing the original bill.

What policy issues will Congress need to tackle after Dec. 20th?

There is must-pass legislation that Congress will need to address before the end of the year. This includes extending the telehealth flexibilities, delaying Medicaid Disproportionate Share Hospital (DSH) Program payment cuts, and extending the Medicare Dependent Hospital and Low Volume Hospital programs. For the hospital-at-home program, Congress is considering passing the Hospital Inpatient Services Modernization Act (H.R. 8260/S. 4350), which would extend the program for five years through 2029. For the telehealth flexibilities, Congress is considering only doing a one-year extension for now, which the Congressional Budget Office (CBO) estimates will cost Medicare $2 billion.

In order to pay for the extension of these programs and delay or mitigate many of the payment cuts slated to take effect on January 2025 (click here for a summary), one of the policies that Congress is considering is to adopt site neutral payments for drug administration services. Under this policy, off-campus Outpatient Hospital Departments would be paid at the lower, physician payment rate for administering drugs. According to the CBO, this policy – included in Sec. 203 of the Lower Costs, More Transparency Act – would save the government approximately $4 billion.

Another policy Congress is eyeing as a pay-for is to repeal a Biden Administration Skilled Nursing Facility (SNF) staffing rule, which CBO estimates could save the government $22 billion over 10 years. This final SNF rule is already being legally challenged as well. It’s still uncertain what Congress will ultimately use as a pay-for; AHPA will continue to monitor these discussions. The primary criticism of the rule lies in concerns that many facilities may have to limit access due to insufficient workforce; particularly in rural and underserved communities. On September 18th, House Energy & Commerce Committee Republicans advanced a bill blocking the implementation of the Rule on a party-line vote, highlighting the partisan nature of overturning a Democratic Administration’s rule. The rule is also facing a legal challenge, and is vulnerable to repeal through the courts. Subsequently, fiscally conservative lawmakers may view any savings from blocking the rule as a budgetary gimmick. It’s still uncertain what Congress will ultimately use as a pay-for, but an additional $22 billion in offsets would dramatically expand what Congress could do in a Lame Duck session – AHPA will continue to monitor these discussions.